NPIMap

Organization Active NPI

Prime Rehab Services, Inc.

  • Rehabilitation Clinic/Center
  • Waterford, MI
National Provider Identifier
1932106945
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PRIME REHAB SERVICES, INC.
Practice address
2590 Elizabeth Lake Rd
Waterford, MI 48328-3314
Phone
(248) 681-0854
NPI assigned
Jul 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Quratulann Moghul-Plemons, P.T.
Title
Administrator/Owner
Phone
(248) 681-0854

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

2590 Elizabeth Lake Rd
Waterford, MI 48328-3314

Mailing address

33341 Dequindre
Suite C
Troy, MI 48083-4630
Phone (248) 588-1388

Other identifiers 1

IdentifierTypeStateIssuer
30485OtherMIBCBSM

Other names 1

  • Prime Rehab Services Doing business as

National Provider Directory

National Provider Directory

Locations

160 Vester St
Ferndale, MI 48220
Phone (248) 543-5541

33341 Dequindre Rd
Ste C
Troy, MI 48083
Phone (248) 255-1306

2590 Elizabeth Lake Rd
Ste B
Waterford, MI 48328
Phone (248) 681-0854

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1932106945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33341 DEQUINDRE",
            "address_2": "SUITE C",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480834630",
            "telephone_number": "248-588-1388",
            "fax_number": "248-543-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2590 ELIZABETH LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283314",
            "telephone_number": "248-681-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME REHAB SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "MOGHUL-PLEMONS",
        "authorized_official_first_name": "QURATULANN",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "248-681-0854",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "30485",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prime Rehab Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prime Rehab Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.